2. Background Review
2.1. COVID-19 in the Elderly
2.2. COVID-19 and Mental Health of the Elderly
2.3. Considerations for Providing Psychological and Mental Health Guidelines for the Elderly during COVID-19
2.4. Suggestions for the Psychological and Mental Health of the Elderly during COVID-19
Conflicts of Interest
- Friedman, T.L. Our New Historical Divide: B.C. and A.C.—The World Before Corona and the World After. The New York Times. 17 March 2020. Available online: https://www.nytimes.com/2020/03/17/opinion/coronavirus-trends.html (accessed on 8 August 2020).
- World Health Organization. COVID-19 Public Health Emergency of International Concern (PHEIC) Global Research and Innovation Forum. Available online: https://www.who.int/publications/m/item/covid-19-public-health-emergency-of-international-concern-(pheic)-global-research-and-innovation-forum (accessed on 21 July 2020).
- World Health Organization. Archive: WHO Timeline-COVID-19. Available online: https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19 (accessed on 21 July 2020).
- Bao, Y.; Sun, Y.; Meng, S.; Shi, J.; Lu, L. 2019-nCoV epidemic: Address mental health care to empower society. Lancet 2020, 395, e37–e38. [Google Scholar] [CrossRef]
- Reardon, S. Ebola’s mental-health wounds linger in Africa: Health-care workers struggle to help people who have been traumatized by the epidemic. Nature 2015, 519, 13–15. [Google Scholar] [CrossRef] [PubMed]
- Shin, J.; Park, H.Y.; Kim, J.L.; Lee, J.J.; Lee, H.; Lee, S.H.; Shin, H.S. Psychiatric Morbidity of Survivors One Year after the Outbreak of Middle East Respiratory Syndrome in Korea, 2015. J. Korean Neuropsychiatr. Assoc. 2019, 58, 245–251. [Google Scholar] [CrossRef]
- Lee, A.M.; Wong, J.G.; McAlonan, G.M.; Cheung, V.; Cheung, C.; Sham, P.C.; Chu, C.-M.; Wong, P.-C.; Tsang, K.W.T.; Chua, S.E. Stress and Psychological Distress among SARS Survivors 1 Year after the Outbreak. Can. J. Psychiatry 2007, 52, 233–240. [Google Scholar] [CrossRef] [PubMed]
- Lee, E. COVID-19 Generation, How Are Your Mental Health? Issue Diagn. 2020, 414, 1–25. Available online: http://www.riss.kr/link?id=A106890715 (accessed on 8 August 2020).
- Park, J.E.; Kang, S.-H.; Won, S.-D.; Roh, D.; Won-Hyoung, K. Assessment Instruments for Disaster Behavioral Health. Anxiety Mood 2015, 11, 91–105. Available online: http://dlps.nanet.go.kr/SearchDetailView.do?cn=KINX2015256297&sysid=nhn (accessed on 8 August 2020).
- Shultz, J.M.; Cooper, J.L.; Baingana, F.; Oquendo, M.A.; Espinel, Z.; Althouse, B.M.; Marcelin, L.H.; Towers, S.; Espinola, M.; McCoy, C.B.; et al. The Role of Fear-Related Behaviors in the 2013–2016 West Africa Ebola Virus Disease Outbreak. Curr. Psychiatry Rep. 2016, 18, 104. [Google Scholar] [CrossRef]
- World Health Organization. Weekly Operational Update on COVID-19. Geneva PP—Geneva: World Health Organization. 2020. Available online: https://www.who.int/publications/m/item/weekly-update-on-covid-19---16-october-2020 (accessed on 25 October 2020).
- Yang, Y.; Li, W.; Zhang, Q.; Zhang, L.; Cheung, T.; Xiang, Y.-T. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry 2020, 7, e19. [Google Scholar] [CrossRef]
- Bialek, S.; Boundy, E.; Bowen, V.; Chow, N.; Cohn, A.; Dowling, N.; Ellington, S.; Gierke, R.; Hall, A.; MacNeil, J.; et al. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)—United States, February 12–March 16, 2020. Morb. Mortal. Wkly. Rep. 2020, 69, 343–346. Available online: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85082470762&doi=10.15585%2Fmmwr.mm6912e2&partnerID=40&md5=48bd8387f0736e8f1e60e5ea2da169a5 (accessed on 11 August 2020).
- Li, Q.; Guan, X.; Wu, P.; Wang, X.; Zhou, L.; Tong, Y.; Ren, R.; Leung, K.S.M.; Lau, E.H.Y.; Wong, J.Y.; et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N. Engl. J. Med. 2020, 382, 1199–1207. [Google Scholar] [CrossRef]
- Niu, S.; Tian, S.; Lou, J.; Kang, X.; Zhang, L.; Lian, H.; Zhang, J. Clinical characteristics of older patients infected with COVID-19: A descriptive study. Arch. Gerontol. Geriatr. 2020, 89, 104058. [Google Scholar] [CrossRef]
- Korean Society of Infectious Diseases; Korea Centers for Disease Control and Prevention. Analysis on 54 Mortality Cases of Coronavirus Disease 2019 in the Republic of Korea from January 19 to March 10, 2020. J. Korean Med. Sci. 2020, 35, e132. [Google Scholar] [CrossRef]
- Verity, R.; Okell, L.C.; Dorigatti, I.; Winskill, P.; Whittaker, C.; Imai, N.; Cuomo-Dannenburg, G.; Thompson, H.; Walker, P.G.T.; Fu, H. Estimates of the severity of coronavirus disease 2019: A model-based analysis. Lancet Infect. Dis. 2020, 20, 669–677. [Google Scholar] [CrossRef]
- Nikolich-Zugich, J.; Knox, K.S.; Rios, C.T.; Natt, B.; Bhattacharya, D.; Fain, M.J. SARS-CoV-2 and COVID-19 in older adults: What we may expect regarding pathogenesis, immune responses, and outcomes. GeroScience 2020, 42, 505–514. [Google Scholar] [CrossRef]
- Heo, J.Y. Clinical and Epidemiological Characteristics of Coronavirus Disease 2019 in the Early Stage of Outbreak. Korean J. Med. 2020, 95, 67–73. [Google Scholar] [CrossRef]
- Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J. Pediatr. 2020, 87, 281–286. [Google Scholar] [CrossRef]
- Kim, J. Clinical Feature of Coronavirus Disease 2019 in Elderly. Korean J. Clin. Geri. 2020, 21, 1–8. Available online: http://scholar.dkyobobook.co.kr.libproxy.syu.ac.kr:8080/searchDetail.laf?barcode=4010027792736 (accessed on 12 August 2020). [CrossRef]
- Wang, C.; Pan, R.; Wan, X.; Tan, Y.; Xu, L.; Ho, C.S.; Ho, R.C. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int. J. Environ. Res. Public Health 2020, 17, 1729. [Google Scholar] [CrossRef]
- Meng, H.; Xu, Y.; Dai, J.; Zhang, Y.; Liu, B.; Yang, H. Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Res. 2020, 289, 112983. [Google Scholar] [CrossRef] [PubMed]
- Qiu, J.; Shen, B.; Zhao, M.; Wang, Z.; Xie, B.; Xu, Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen. Psychiatry 2020, 33, e100213. [Google Scholar] [CrossRef]
- World Health Organization. Coronavirus Desease 2019 (COVID-19) Situation Report—89. 2020. Available online: https://www.who.int/docs/default-source/coronaviruse/situa%0Ation-reports/20200418-sitrep-89-covid-19.pdf?sfvrsn=3643dd38_2%0D (accessed on 11 August 2020).
- Gerst-Emerson, K.; Jayawardhana, J. Loneliness as a Public Health Issue: The Impact of Loneliness on Health Care Utilization Among Older Adults. Am. J. Public Health 2015, 105, 1013–1019. [Google Scholar] [CrossRef]
- Ornell, F.; Schuch, J.B.; Sordi, A.O.; Kessler, F.H.P. “Pandemic fear” and COVID-19: Mental health burden and strategies. Braz. J. Psychiatry 2020, 42, 232–235. [Google Scholar] [CrossRef] [PubMed]
- Shin, L.M.; Liberzon, I. The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology 2010, 35, 169–191. [Google Scholar] [CrossRef] [PubMed]
- Shigemura, J.; Ursano, R.J.; Morganstein, J.C.; Kurosawa, M.; Benedek, D.M. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry Clin. Neurosci. 2020, 74, 281–282. [Google Scholar] [CrossRef] [PubMed]
- Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020, 395, 912–920. [Google Scholar] [CrossRef]
- Xiang, Y.-T.; Yang, Y.; Li, W.; Zhang, L.; Zhang, Q.; Cheung, T.; Ng, C.H. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020, 7, 228–229. [Google Scholar] [CrossRef]
- Yip, P.S.F.; Cheung, Y.T.; Chau, P.H.; Law, Y.W. The Impact of Epidemic Outbreak: The Case of Severe Acute Respiratory Syndrome (SARS) and Suicide Among Older Adults in Hong Kong. Crisis 2010, 31, 86–92. [Google Scholar] [CrossRef]
- Meisner, B.A. Are You OK, Boomer? Intensification of Ageism and Intergenerational Tensions on Social Media Amid COVID-19. Leis. Sci. 2020, 1–6. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. Coping with Stress. Coronavirus Disease 2019 (COVID-19). 2020. Available online: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html (accessed on 15 August 2020).
- Park, S.-C.; Park, Y.C. Mental Health Care Measures in Response to the 2019 Novel Coronavirus Outbreak in Korea. Psychiatry Investig. 2020, 17, 85–86. [Google Scholar] [CrossRef]
- Chang, S.O.; Kong, E.S.; Kim, K.B.; Kim, N.C.; Kim, J.H.; Kim, C.G.; Kim, H.K.; Song, M.S.; Ahn, S.Y.; Lee, K.J.; et al. The Concept Analysis of Ego-integrity in the Elderly. J. Korean Acad. Nurs. 2004, 34, 1172. [Google Scholar] [CrossRef]
- Santor, D.A.; Zuroff, D.C. Depressive Symptoms: Effects of Negative Affectivity and Failing to Accept the Past. J. Pers. Assess. 1994, 63, 294–312. [Google Scholar] [CrossRef]
- Erikson, E.H.; Erikson, J.M.; Helen, Q.K. Vital Involvement in Old Age; W. W. Norton & Company: New York, NY, USA, 1986. [Google Scholar]
- Wilburn, V.R.; Smith, D.E. Stress, self-esteem, and suicidal ideation in late adolescents. Adolescence 2005, 40, 33–45. [Google Scholar]
- Bandura, A. Self-Efficacy: The Exercise of Control; Freeman and Company: New York, NY, USA, 1997. [Google Scholar]
- Cho Seongja, K.B. The Relationship between Stress and Life Satisfaction among the Elderly: The Mediating Effects of Depression, Self-Efficiency and Mindfulness. Korea Gerontol. 2014, 34, 49–71. Available online: http://scholar.dkyobobook.co.kr.libproxy.syu.ac.kr:8080/searchDetail.laf?barcode=4010023763080 (accessed on 15 August 2020).
- Manning, M.M.; Wright, T.L. Self-efficacy expectancies, outcome expectancies, and the persistence of pain control in childbirth. J. Pers. Soc. Psychol. 1983, 45, 421–431. [Google Scholar] [CrossRef]
- Gattuso, S.M.; Litt, M.D.; Fitzgerald, T.E. Coping with gastrointestinal endoscopy: Self-efficacy enhancement and coping style. J. Consult. Clin. Psychol. 1992, 60, 133–139. [Google Scholar] [CrossRef] [PubMed]
- Maciejewski, P.K.; Prigerson, H.G.; Mazure, C.M. Self-efficacy as a mediator between stressful life events and depressive symptoms. Br. J. Psychiatry 2000, 176, 373–378. [Google Scholar] [CrossRef]
- Wagnild, G. Resilience and Successful Aging: Comparison Among Low and High Income Older Adults. J. Gerontol. Nurs. 2003, 29, 42–49. [Google Scholar] [CrossRef] [PubMed]
- MacLeod, S.; Musich, S.; Hawkins, K.; Alsgaard, K.; Wicker, E.R. The impact of resilience among older adults. Geriatr. Nurs. 2016, 37, 266–272. [Google Scholar] [CrossRef]
- Fergus, S.; Zimmerman, M.A. Adolescent Resilience: A Framework for Understanding Healthy Development in the Face of Risk. Annu. Rev. Public Health 2005, 26, 399–419. [Google Scholar] [CrossRef]
- Folkman, S.; Lazarus, R.S. An Analysis of Coping in a Middle-Aged Community Sample. J. Health Soc. Behav. 1980, 21, 219–239. [Google Scholar] [CrossRef]
- Lazarus, R.S.; Folkman, S. Stress, Appraisal, and Coping; Springer Publishing Company: New York, NY, USA, 1984. [Google Scholar]
- Berkman, L.F.; Syme, S.L. Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. Am. J. Epidemiol. 1979, 109, 186–204. [Google Scholar] [CrossRef]
- Kim, O.S.; Baik, S.H. The Relationships among Loneliness, Social Support, and Family Function in Elderly Korean. J. Korean Acad. Nurs. 2003, 33, 425–432. [Google Scholar] [CrossRef]
- Krause, N. Religion, Aging, and Health: Current Status and Future Prospects. J. Gerontol. B Psychol. Sci. Soc. Sci. 1997, 52B, S291–S293. [Google Scholar] [CrossRef]
- Jin, K.C. Life Satisfaction among the Rural Elderly: With a Special Focus on the Impact of Religious Life. Korean J. Local Gov. Adm. Stud 2011, 25, 208–303. [Google Scholar]
- Kang, S.-B.; Cho, S.-S. Effects of Religious Activities and Faith Attitudes on Depression and Ego-Integrity of the Elderly. J. Korea Contents Assoc. 2013, 13, 325–346. [Google Scholar] [CrossRef]
- Chodzko-Zajko, W.J.; Proctor, D.N.; Fiatarone Singh, M.A.; Minson, C.T.; Nigg, C.R.; Salem, G.J.; Skinner, J.S. Exercise and Physical Activity for Older Adults. Med. Sci. Sports Exerc. 2009, 41, 1510–1530. [Google Scholar] [CrossRef]
- Rejeski, W.J.; Mihalko, S.L. Physical Activity and Quality of Life in Older Adults. J. Gerontol. A Biol. Sci. Med. Sci. 2001, 56, 23–35. [Google Scholar] [CrossRef] [PubMed]
- Murphy, S.L.; Williams, C.S.; Gill, T.M. Characteristics Associated with Fear of Falling and Activity Restriction in Community-Living Older Persons. J. Am. Geriatr. Soc. 2002, 50, 516–520. [Google Scholar] [CrossRef]
- Bang, Y.-S.; Kim, H.-Y.; Heo, M. Relationships between Physical Activity Participation, Depression and Body Function of the Elderly in Community. J. Korea Contents Assoc. 2009, 9, 227–237. [Google Scholar] [CrossRef]
- Gill, D.L.; Kelley, B.C.; Williams, K.; Martin, J.J. The Relationship of Self-Efficacy and Perceived Well-Being to Physical Activity and Stair Climbing in Older Adults. Res. Q. Exerc. Sport 1994, 65, 367–371. [Google Scholar] [CrossRef]
- World Health Organization. Mental Health and Psychosocial Considerations during Outbreak, COVID-19. 2020. Available online: https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf (accessed on 15 August 2020).
- Jones, L. Big Ones; Anchor: New York, NY, USA, 2019. [Google Scholar]
|Psychological Concepts||Psychological and Mental Influences|
|Stress||Stress not only causes psychological and mental distress and aggravates psychiatric symptoms, but may also lead to suicide in severe cases, according to recent studies conducted during the COVID-19 outbreak.|
|Ego-integrity||Constant exposure to high stress levels, such as those caused by COVID-19 among the elderly decreases expectations toward the self, damages positive self-perception, and can lead to loss of self-worth and depression; further contributing to or even causing other mental health problems.|
|Self-efficacy||Self-efficacy is a major variable that predicts adaptation and plays an important role in behavioral change, physical health, mental problems, and psychological adaptation. This may affect the degree to which the elderly can control and cope with events in stressful situations caused by COVID-19.|
|Resilience||High resilience among the elderly predicts variables such as high coping skills, long lifespan, low depression, a positive mind, strong social support networks, and dynamic physical activity; thus, resiliency is particularly important among the elderly where psychological, social, physical, and socio-economic stresses are highest among all age groups, especially during COVID-19.|
Stress caused by COVID-19
|(1) Stop reading, watching, and listening to news, including social media, about the pandemic because repeated exposure can cause stress and anxiety. |
(2) Refrain from spreading unofficial information.
(3) Understand that it is normal to feel stress and fear in unpredictable situations.
(4) Take deep breaths, stretch the body, and perform yoga or meditation.
(5) Give attention to one’s needs, emotions, and thoughts.
(6) Determine actions after considering collective and social influences.
(7) Refrain from discriminating or blaming specific individuals or groups for the infection.
(8) Take care of and encourage oneself.
(9) Those with disabilities, such as mental illnesses or drug abuse, may be particularly vulnerable in an emergency, and thus, must continue with the treatment. Notice new symptoms or the worsening of existing symptoms, in which case, ask for medical help.
|(1) Maintain contact with family and friends. |
(2) Maintain regular religious activities and contact with the local community.
(3) Be informed, in advance, of where and how to receive counseling and other supporting services.
(4) Notify close family and friends when symptoms of sadness, depression, and anxiety occur.
|(1) Maintain a daily schedule and exercise pattern. |
(2) Have regular habits to maintain good health.
(3) Make time for leisure activities and find enjoyable activities.
(4) Maintain a healthy and balanced diet.
(5) Obtain enough sleep.
(6) Avoid excessive drinking and drug use.
(7) Take prescriptive medicine as usual.
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